A public policy expert says today that it is time to abandon commissioning in the English NHS. Writing in an editorial on bmj.com, Professor Calum Paton from Keele University says the system is failing.

Professor Paton says that since 1991, purchasing or commissioning “has mutated through a series of confusing and frequent reorganisations, involving mutually incompatible policies and high costs.” He believes it should be dropped and replaced with a more integrated approach offering patients real choice and which could combine financial savings with quality.

Commissioning began officially in 1997, when the Labour government dropped the previous Conservative administration’s term “purchasing. The aim, he explains, was to signal the end of the competitive market culture and its replacement with collaboration between purchasers authorities, and providers. The split between purchaser and provider remained, he says, and from 2002 the market was revived and commissioning became part of it.

Professor Paton points to a recent Commons’ Health Select Committee report which said commissioning costs now account for 14 per cent of the NHS budget. He looks at the options recently put forward by the Nuffield Trust and King’s Fund, but says they would be “complex and incur high costs” and would continue the purchaser-provider split.

Challenging the widely held view that primary care trusts cannot control powerful hospitals, referrals, and admissions he says the major challenge for the NHS is to combine financial savings with quality. But, he warns: “This cannot be achieved with commissioners who are distinct from the doctors and hospitals that provide care.”

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